Claim Form.

Organiser Details

Organising Body:
Contact:
Title of Course:
Date of Course: (format of : yyyy-mm-dd)
DOCET Reference:

Course Overhead Expenses to be met by DOCET

Payment to lectures / tutors
(1) Fees £
(2) Travel and accommodation: £
Room hire for course: £
Advertising OR local mailshot costs: £
Hire of equipment: £
Payment to patients: £
Other costs: ( Please Specify )
£
TOTAL: £
Percentage of non-optometrists attending course: % (Please enter a number between 0 (zero) and 100)
TOTAL MINUS PERCENTAGE: £
Total Number of lecture/workshop hours:
Capped amount: £
Excess £
TOTAL MINUS EXCESS £

Actual Overheads not met by DOCET

Administrative costs: £
Refreshments: £
Other costs: ( Please Specify )
£
TOTAL: £

Revenue Received

Total attendees:
Fee charged: £
TOTAL: £
Percentage Profit: %
Excess: £
TOTAL EXPENSES TO BE MET BY DOCET MINUS EXCESS: £
Are you applying for funding from other sources? Yes No
If yes, how much? £
TOTAL TO BE PAID (CAPPED AT £5000): £